Aarons Gregory A, Conover Kate L, Ehrhart Mark G, Torres Elisa M, Reeder Kendal
Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
Child and Adolescent Services Research Center, San Diego, California, USA.
J Health Organ Manag. 2020 Dec 1;35(1):68-87. doi: 10.1108/JHOM-10-2019-0311.
Clinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader-member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.
DESIGN/METHODOLOGY/APPROACH: Survey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader-member exchange with organizational climate and turnover intentions.
Lower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.
ORIGINALITY/VALUE: This study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader-follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor-supervisee relationships.
心理健康机构中的临床医生流动会影响服务质量，包括循证实践的可及性和提供情况。领导力与组织氛围、团队功能及临床医生的离职意向（TI）相关。本研究使用团队平均领导-成员交换关系（LMX）、个体临床医生评分与团队成员评分相比的离散度（即相对LMX）以及团队层面的变异性（即LMX分化）来考察领导-成员交换关系，该关系反映了主管与每位被监督者之间的关系，并探讨其与组织氛围和临床医生离职意向的关系。
设计/方法/途径：从嵌套于儿童心理健康机构工作小组的363名临床医生那里收集了调查数据，这些工作小组为青少年及家庭提供县合同门诊服务。一项有调节的中介路径分析考察了领导-成员交换关系与组织氛围和离职意向的跨层次关联。
较低的相对LMX和较高的LMX分化与临床医生较高的离职意向相关。较高的团队层面的士气低落氛围也预示着较高的离职意向。这些结果表明，较差的LMX以及团队层面LMX的更大变异性与临床医生的离职意向有关。
原创性/价值：本研究描述了影响临床医生离职意向的团队层面和临床医生层面的因素。很少有研究考察心理健康领域的LMX，更少有人研究相对LMX以及LMX分化与组织氛围和离职意向的关联。这些结果凸显了领导-下属关系和组织氛围及其与临床医生离职意向的关联的重要性。心理健康服务系统和组织可以通过培养更积极的主管-被监督者关系来解决这些问题。
